Provider Demographics
NPI:1790219632
Name:ALL SEASONS ACUPUNCTURE & WELLNESS, LLC
Entity Type:Organization
Organization Name:ALL SEASONS ACUPUNCTURE & WELLNESS, LLC
Other - Org Name:ALL SEASONS ACUPUNCTURE & WELLNESS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUTUM
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:980-404-9477
Mailing Address - Street 1:222 N LAFAYETTE ST STE 24
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4450
Mailing Address - Country:US
Mailing Address - Phone:980-404-9477
Mailing Address - Fax:704-495-6681
Practice Address - Street 1:222 N LAFAYETTE ST STE 24
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4450
Practice Address - Country:US
Practice Address - Phone:980-404-9477
Practice Address - Fax:704-495-6681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNCALB 836171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty